We report three cases of schwannoma originating in the nasal and paranasal sinus. A 59-year-old female complained of right nasal obstruction due to right nasal tumor attached to the nasal septum. Histopathological analysis of the right nasal tumor showed that it was an Antoni type A schwannoma. En block tumor resection was performed endoscopically.The second case was a 72-year-old female who was diagnosed following MRI conducted as part of a periodic health examination. The tumor originated in the ethmoidal sinus and appeared as a round mass. CT revealed bone degeneration of the medial wall of the orbit. An intraoperative diagnosis of schwannoma without malignancy was made. The entire tumor was resected endoscopically. The resected tumor was diagnosed as an Antoni type A schwannoma on the basis of positive immunohistochemical results for the anti-S-100 antibody. There were no malignant findings.The third case was 34-year-old female who complained of right nasal obstruction. CT showed a soft tissue density mass occupying the entire right nasal cavity. We suspected schwannoma from biopsy. The tumor was removed completely by endoscopic sinus surgery. The tumor was originated from the anterior part of the nasal septum. The histopathological findings revealed it to be Antoni A and B type schwannoma.The three patients showed no tumor recurrence or metastasis after operation.

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IgG4-related sclerosing disease is a well-recognized systemic chronic inflammatory disease histologically characterized by infiltration of IgG4-positive plasma cells and extreme fibrosis. It involves multiple organs and is assotiated with many chronic inflammatory diseases, such as autoimmune pancreatitis, retroperitoneal fibrosis, Mikulicz’s disease, and Küttner’s tumor. Recently, many cases of IgG4-related sclerosing disease with rhino-sinus involvements have been reported. Here, we report two cases of IgG4-related sclerosing disease with nasal involvement. Case 1, a 56-year-old male of Mikulicz’s disese complained of nasal obstruction and nasal bleeding. The nasal mucosa was covered with crust and susceptible to bleeding. Pathologic findings showed infiltration of IgG4-positive plasma cells in the nasal mucosa. Serum IgG4 level was 2,500mg/dl (maximum). Case 2, 76 year-old-male with Küttner’s tumor complained of nasal obstruction and nasal bleeding. The nasal mucosa was covered with thick crust and susceptible to bleeding. There was also a small polyp in the nasal cavity. Pathologic findings showed infiltration of IgG4-positive plasma cells in nasal mucosa. Serum IgG4 level was 1,260mg/dl (maximum). In both cases, nasal steroids were not effective. Oral steroids were effective for sialadenitis, dacryadenitis, dry mouth, and nasal symptoms. IgG4-related sclerosing disease should be included in the differential diagnosis of abnormal rhinitis, when the nasal mucosa is covered with crust and susceptible to bleeding.

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In the treatment of orbital blowout fracture, we use a lower eyelid incision or medial angle incision. When we make the lower eyelid incision, we cut the skin between the subcilial line and lower orbital rim. This helps us obtain a wide operative field and invisible scar. In the case of a medial canthus incision, we have to cut the medial canthus ligament and anterior and posterior ethmoidal arteries to obtain a suitable operative field. After cutting the medial canthus ligament, accurate suturing of the ligament is subsequently required to maintain the shape of the medial canthus. The orbit must be dissected until we can confirm the edge of all bone defects to collect all orbital contents from paranasal sinuses into the orbit, and a graft is then placed securely over the edge of the bone defect. Reconstruction of the orbital wall is necessary to prevent the re-escape of orbital contents, and is carried out by closing the bone defect using the graft. The transplant materials for grafting should be as thin as possible. In addition, materials that are relatively resistant to infection are needed. The iliac inner plate is thin and will take as living tissue, and can therefore support the orbital contents semi-permanently. The iliac inner plate is thus suitable as a graft material for the orbit.

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[in Japanese]

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